title: Budget impact of parenteral iron treatment of iron deficiency: methodological issues raised by using real-life data.
abstract: OBJECTIVE
  Iron deficiency is common in pregnancy, postpartum, inflammatory bowel disease, chronic kidney disease, chronic heart failure, heavy uterine bleeding, cancer and following surgery. We estimate the budget impact (BI) on the Swiss mandatory health insurance associated with substituting iron sucrose (standard) with ferric carboxymaltose (new treatment) using real-life data.
  
  
  METHODS
  Resource use was based on recent primary data (Polyquest Prescriber Analysis, Anemia Patient Record Study in Switzerland). Personnel costs were estimated using the Swiss Tarmed fee-for-service reimbursement system. Drug costs and costs of materials used were based on official tariffs (Spezialitätenliste, MiGeL). Actual IMS sales data of both products were used to verify the BI model (1 CHF ≈ 1 USD, Jan 2013).
  
  
  RESULTS
  Ferric carboxymaltose was associated with cost savings of 30-44 % per patient per treatment cycle compared to iron sucrose. Costs per 200/500/1,000 mg total dosage treatment cycle were CHF 101/210/420 for ferric carboxymaltose and CHF 144/375/721 for iron sucrose. This results in cost savings of CHF 22-31 million across all indications in 2009. Savings were driven by personnel cost reductions (application time and number of applications). Sensitivity analyses confirmed these cost savings, even for the higher application costs of ferric carboxymaltose, with minimum savings of CHF 17 million per year.
  
  
  CONCLUSIONS
  Treating iron deficiency involves substantial costs to the Swiss MHI which may be reduced by substituting iron sucrose with ferric carboxymaltose. The use of real-life data raises methodological questions about the fundamental compatibility of this data with the conceptual framework of BI analysis.
authors.affiliation: HealthEcon AG, Steinentorstrasse 19, 4051, Basel, Switzerland, ebrock@healthecon.com.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brock
authors.forename: Peter
authors.initials: P
authors.lastname: Braunhofer
authors.forename: Josef
authors.initials: J
authors.lastname: Troxler
authors.forename: Heinz
authors.initials: H
authors.lastname: Schneider
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy*; D002017:Budgets; D017046:Cost Savings; D057915:Drug Substitution / Q000191:economics; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage / Q000191:economics*; D000077605:Ferric Oxide, Saccharated; D005382:Financing, Personal; D005937:Glucaric Acid / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D008320:Maltose / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D009313:National Health Programs / Q000191:economics*; D013557:Switzerland
chemical_list: D005290:Ferric Compounds; C522335:ferric carboxymaltose; D008320:Maltose; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid